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pre-ablation CT scan

Posted by kbog 
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kbog
pre-ablation CT scan
January 15, 2019 08:09PM
Can anyone shed light on the use of CT scan before an afib ablation (why it is needed, what information is gained)?

I'm kind of assuming it shows presence/absence of thrombus, heart morphology... what other useful information will it yield? Will I have an idea of the condition of my arteries/calcification/etc from the report?

I had only a TEE before my flutter ablation, and I suppose the radiation exposure from the CT scan is a little bit concerning to me.

In the event Dr. Natale needs to do a follow-up ablation at some later date, would he order another CT scan?

Karen
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mwcf
Re: pre-ablation CT scan
January 15, 2019 10:16PM
I had a CT scan rather than a TEE before my ablation at Bordeaux last year. Maybe simply varies from centre to centre. Either way is to exclude any thrombus prior to the ablation procedure.
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Carey
Re: pre-ablation CT scan
January 15, 2019 10:55PM
The data from the CT scan is fed into their mapping system so it will have a precise anatomical map of your heart. It's absolutely essential to an afib ablation. (Flutter ablations are usually much simpler.) And yes, it would also reveal things like a thrombus being present. A second ablation wouldn't require another scan unless it was years later or you had it done at another center.
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Sam
Re: pre-ablation CT scan
January 16, 2019 10:20AM
Bordeaux didn't require me to have a CT scan, just a TEE.
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Carey
Re: pre-ablation CT scan
January 16, 2019 02:28PM
Quote
Sam
Bordeaux didn't require me to have a CT scan, just a TEE.

I can't explain why Bordeaux does what they do. Just explaining why CTs are used by Natale's group.
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kbog
Re: pre-ablation CT scan
January 16, 2019 05:00PM
Thanks for the explanation, Carey. Since it sounds like you may also know the answer to this question: Is there still x-ray exposure during the procedure as well then, or does the pre-ablation CT scan eliminate most/all of the need for that?

I wish it were possible to be a fly on the wall at my own procedure. I find medical technology absolutely fascinating.
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dartisskis
Re: pre-ablation CT scan
January 16, 2019 09:53PM
As Carrey explained above it is done for the mapping system. Think of it as GPS map of your heart. Interestingly enough Dr. Natale did not require CT scan for my second ablation which happened 10 years after the first one. It surprised me a bit. I was told that it is not necessary and most likley nothing changed since my first ablation.

Deniss



Edited 2 time(s). Last edit at 01/16/2019 09:54PM by dartisskis.
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wolfpack
Re: pre-ablation CT scan
January 17, 2019 02:20AM
Is it a CT and not an MRI? I suppose both are used. Mine was a delayed-enhancement MRI, says so on the report.
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Carey
Re: pre-ablation CT scan
January 17, 2019 02:49AM
Quote
kbog
Is there still x-ray exposure during the procedure as well then, or does the pre-ablation CT scan eliminate most/all of the need for that?

It does not eliminate the need for fluoroscopy (x-ray) during the procedure, but it does minimize it. The amount of radiation involved is really fair trivial. You'll get a higher dose from a flight to Austin than from the procedures.
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Carey
Re: pre-ablation CT scan
January 17, 2019 02:51AM
Quote
wolfpack
Is it a CT and not an MRI? I suppose both are used. Mine was a delayed-enhancement MRI, says so on the report.

I also had a delayed-enhancement MRI prior to one of my ablations. They used that instead of a CT for feeding into their mapping system, so I believe it's a choice of one or the other but not both.
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mwcf
Re: pre-ablation CT scan
January 17, 2019 07:15AM
Quote
Carey

Is it a CT and not an MRI? I suppose both are used. Mine was a delayed-enhancement MRI, says so on the report.

I also had a delayed-enhancement MRI prior to one of my ablations. They used that instead of a CT for feeding into their mapping system, so I believe it's a choice of one or the other but not both.

Actually thinking about it.... it might have been an MRI I had just before my ablation - I was vaguely aware (already somewhat sedated) of being placed inside a large doughnut with some circular whizzing noises for 10 minutes or so..... never had a CT or MRI before but maybe what I had was an MRI?
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Gill
Re: pre-ablation CT scan
January 17, 2019 10:43AM
Mike

You would have known if it was an MRI scan, I assure you! It used to be called NMRI - Nuclear Magnetic Resonance Imaging but the N was dropped because it had negative connotations.

I had one (not heart related) and it takes place in the Department of Nuclear Medicine. You get injected with radioactive stuff then have to sit in a special shielded room while your body absorbs it. The scan takes much longer than a CT, and the machine makes a very loud noise.

After the scan you have to stay away from young children for some hours because you’re dangerous.

You would definitely have known!!

Gill
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mwcf
Re: pre-ablation CT scan
January 17, 2019 12:49PM
Hi Gill,
Thank you for your input.
Not that I know what I'm talking about here, but can't one have a MRI without 'contrast' (the radioactive stuff!)??
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wolfpack
Re: pre-ablation CT scan
January 17, 2019 03:34PM
Yes, you can have an MRI without the contrast. I wasn't injected with anything.

A CT scanner has a big, rotating ring and the scan is much shorter.

An MRI is a stationary "doughnut" and buzzes like crazy when the field is engaged. The scan takes a lot longer. Often times they'll give you headphones to listen to music while they do the scan but, yeah, forget that working when the thing is on. I'm an EE myself and I couldn't design an amplifier with decent noise rejection in a 3 Tesla magnetic field!
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kbog
Re: pre-ablation CT scan
January 17, 2019 05:42PM
Huh. Very interesting. I had a cardiac MRI (including "late gadolinium enhancement") about 15 months ago and have the disc... But, I'd just as soon have TCAI do a CT scan if that's what they're used to... and I'd just as soon skip the TEE that I'd probably otherwise have to have. smiling smiley

I think the MRI procedure might be a little different depending on where you have it. With my MRI (which was a long procedure), they didn't inject me with the gadolinium until halfway through, and I don't remember any cautions about being around my kids. The whole thing was a pretty positive / fascinating experience, and I walked out that day with a copy of the results on disc in hand, which I thought was pretty cool (though I had to wait for the reviewing doctor's report).

Nice to know the CT scan is quick and painless.

Thanks for all the info!
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mwcf
Re: pre-ablation CT scan
January 17, 2019 08:23PM
Quote
wolfpack
Yes, you can have an MRI without the contrast. I wasn't injected with anything.

A CT scanner has a big, rotating ring and the scan is much shorter.

An MRI is a stationary "doughnut" and buzzes like crazy when the field is engaged. The scan takes a lot longer. Often times they'll give you headphones to listen to music while they do the scan but, yeah, forget that working when the thing is on. I'm an EE myself and I couldn't design an amplifier with decent noise rejection in a 3 Tesla magnetic field!

Thanks Wolfpack. It was definitely a CT scan I had pre-ablation last summer at Bordeaux. Needless to say I was relieved not to get a TEE!
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libby
Re: pre-ablation CT scan
January 19, 2019 07:44PM
I believe the CT also shows your calcium score or your risk of coronary disease. A-fib can be caused by blockages/coronary arteries feed the conduction system. This would be important to know/rule out before the ablation.
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Carey
Re: pre-ablation CT scan
January 19, 2019 09:06PM
A CT scan can detect a number of things but the sole purpose of a pre-ablation CT is to provide an anatomical map for the mapping system they use during the procedure.
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kbog
Re: pre-ablation CT scan
January 21, 2019 07:31PM
Thanks, libby - I was wondering that.

If the same test conducted in the same manner can yield additional useful health information, it seems like that should be part of the report, regardless of the specific reason the test is being ordered... so hopefully that will be the case...
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mwcf
Re: pre-ablation CT scan
January 23, 2019 09:07AM
Quote
Carey
A CT scan can detect a number of things but the sole purpose of a pre-ablation CT is to provide an anatomical map for the mapping system they use during the procedure.

Carey, you posted earlier in this thread:
"The data from the CT scan is fed into their mapping system so it will have a precise anatomical map of your heart. It's absolutely essential to an afib ablation. (Flutter ablations are usually much simpler.) And yes, it would also reveal things like a thrombus being present. A second ablation wouldn't require another scan unless it was years later or you had it done at another center."

I'm assuming that a CT scan does indeed show if any thrombus is present as I didn't get an MRI or a TEE last year in Bordeaux! My ablation was performed with the Carto system - is it Carto that uses the anatomical mapping info from the CT?
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Carey
Re: pre-ablation CT scan
January 23, 2019 03:21PM
Quote
mwcf
My ablation was performed with the Carto system - is it Carto that uses the anatomical mapping info from the CT?

Yes, it does. I think all the mapping systems do.
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mwcf
Re: pre-ablation CT scan
January 23, 2019 05:46PM
Thanks Carey.

One thing still baffling me.... given your earlier comments that a CT would reveal the presence of any thrombus, then anyone having a CT for mapping purposes would not need a TEE? If a MRI can also see if a thrombus is present and is also required for mapping (i.e. as an alternative to CT), then why does anyone need a TEE if they're getting either a CT or a MRI for mapping purposes?? Any clarification you can provide would be appreciated.

Cheers,

Mike
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Carey
Re: pre-ablation CT scan
January 23, 2019 07:35PM
I've never had a TEE prior to an ablation, but there are things a TEE can measure that a CT can't. Think of the output from a TEE as a movie and the output from a CT as a snapshot. TEEs show movement, so things like blood flow, velocity, and turbulence can be measured that wouldn't be measurable with CT.
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mwcf
Re: pre-ablation CT scan
January 23, 2019 08:06PM
Thanks Carey.
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